I came across Dr. Kevin Tolliver’s post, “Beware the Limits of Telemedicine,” and found it to gloss over the benefits of telemedicine and the opportunities that increasing telemedicine uptake can afford to the patient and provider. With this post, I aim to show that these opportunities for systemic change to the health care delivery model – particularly driven by telemedicine – surpass the listed limitations of telemedicine.
The prior post lists potential risks that apply to nearly all new tech services not just telemedicine. Though the tech industry’s routine disregard for legal requirements does not grant carte blanche to offer health technologies with the same regulatory disrespect, it does not mean all patients are “better off heading to [their] PCP’s office or an urgent care center.”
Take rideshare companies as an example. Uber and Lyft saw a gap in service and an opportunity to offer something to the benefit of the consumer – greater access. Telemedicine fits a similar bill.
Rideshare services exploited this opportunity to transport consumers. Telemedicine exploits this opportunity to virtually transport your doctor to you. Lack of regulation rarely stops an early adopter from trying a new tech service, so what makes telemedicine different?
The referenced blog post names the following limitations of telemedicine: geography, malpractice, standard of care, data breaches, and fraud and abuses. To the author, geography, malpractice, and standard of care come down to a lack of standards dictating the expectations of care provided by telemedicine. If telemedicine can cross state borders, which malpractice laws apply? Without a standard of care established, how can a patient file a malpractice claim? When adopting new technologies, these are the risk consumers take and this process helps regulators to determine what regulations are needed.
As for data breaches, each time we input a password or log onto the internet, that’s a risk we take. That’s even how the author frames it, “There is risk of data breach with any internet-based service.” Yet, given the ubiquity of this risk, its telemedicine-specific limitation is just that: limited.
Fraud and abuse offers the greatest risk to the patient with the possibility that patients receive a lower standard of care from a virtual provider lacking credentials. Still, there are opportunities to avoid this without avoiding telemedicine altogether. Seeking telemedicine services through known providers or large medical care providers can reduce the likelihood of being exploited by non-credentialed virtual providers. Further, requiring initial in-person visits with a provider may reduce the potential for abuse.
These limited limitations do not counteract the opportunity for telemedicine to transform health care delivery models across the world. This transformation is long overdue. According to a 2015 Journal of the American Medical Association article by Moses et al., fewer than 30 cents out of every $100 spent on medical care is spent on improving the way care is delivered.
With the rapidly growing population, including those in older age and with chronic conditions, transformation of health care delivery models through telemedicine is necessary to ensure patients can reach providers. In fact, those with chronic conditions account for 80 percent of the health care expenditures in the United States according to the NIHCM Foundation. Studies have demonstrated telemedicine’s ability to reduce health care costs.
The key to this transformation lies not in mentioning all the drawbacks, but increasing adoption and requiring reimbursement for these services. Anyone over 65 years old is eligible for Medicare, yet Medicare only reimburses for telemedicine services for areas where there is a shortage of health professionals. Yet, access to health professionals is not merely a problem of shortage but also ability to travel to those providers. For many older adults, reaching a health care professional can be an all-day task. Monitoring visits, prescription renewal, referrals, or simple questions should not require the lost time and wages of an in-person visit. Peruse clinicaltrials.gov and you will find a plethora of randomized control trials testing the efficacy of telemedicine visits in comparison to in-person visits.
These findings will help support the investment that many large organizations are already embracing. Despite Medicare’s limited coverage, the Department of Veterans Affairs provided more than 2 million virtual visits in 2014. Mayo Clinic plans to virtually serve more than 200 million patients from around the world by 2020.
Any concern about medical malpractice or data privacy that may concern providers should be dissuaded by the huge investment being made in transforming the medical industry through virtual provision. Rather than turning away from this opportunity, providers should embrace it and engage in the process. If not, they may find that they show up at their PCP practice or urgent care center without any “living, breathing humans” to evaluate.
Katey Webber is a public health student.
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